Influence of passive leg movements on blood circulation on the tilt table in healthy adults

Czell David, Schreier Reinhard, Rupp Rüdiger, Eberhard Stephen, Colombo Gery, Dietz, Dietz Volker

Description

One problem in the mobilization of patients with neurological diseases, such as spinal cord injury, is the circulatory collapse that occurs while changing from supine to vertical position because of the missing venous pump due to paralyzed leg muscles. Therefore, a tilt table with integrated stepping device (tilt stepper) was developed, which allows passive stepping movements for performing locomotion training in an early state of rehabilitation. The aim of this pilot study was to investigate if passive stepping and cycling movements of the legs during tilt table training could stabilize blood circulation and prevent neurally-mediated syncope in healthy young adults. Methods In the first experiment, healthy subjects were tested on a traditional tilt table. Subjects who had a syncope or near-syncope in this condition underwent a second trial on the tilt stepper. In the second experiment, a group of healthy subjects was investigated on a traditional tilt table, the second group on the tilt ergometer, a device that allows cycling movements during tilt table training. We used the chi-square test to compare the occurrence of near-syncope/syncope in both groups (tilt table/tilt stepper and tilt table/tilt ergometer) and ANOVA to compare the blood pressure and heart rate between the groups at the four time intervals (supine, at 2 minutes, at 6 minutes and end of head-up tilt). Results Separate chi-square tests performed for each experiment showed significant differences in the occurrence of near syncope or syncope based on the device used. Comparison of the two groups (tilt stepper/ tilt table) in experiment one (ANOVA) showed that blood pressure was significantly higher at the end of head-up tilt on the tilt stepper and on the tilt table there was a greater increase in heart rate (2 minutes after head-up tilt). Comparison of the two groups (tilt ergometer/tilt table) in experiment 2 (ANOVA) showed that blood pressure was significantly higher on the tilt ergometer at the end of head-up tilt and on the tilt table the increase in heart rate was significantly larger (at 6 min and end of head-up tilt). Conclusions Stabilization of blood circulation and prevention of benign syncope can be achieved by passive leg movement during a tilt table test in healthy adults.

Sujets

• Tilt table test
• Circulatory system
• Syncope

Informations

• Publié par: biomed
• Publié le: 01 janvier 2004
• Nombre de lectures: 13
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

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Published: 25 October 2004 Received: 30 August 2004 Journal of NeuroEngineering and Rehabilitation 2004, 1 :4 doi:10.1186/1743-0003-1-4  Accepted: 25 October 2004 This article is available from: http ://www.jneuroengrehab .com/content/1/1/4 © 2004 Czell et al; licensee BioMed Central Ltd. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the orig inal work is properly cited.

tilt steppertilt tableblood circulations yncopenear-syncopevertical mobilization

Abstract Background: One problem in the mobilization of patients with neurological diseases, such as spinal cord injury, is the circulatory collapse that occurs while chan ging from supine to vertic al position because of the missing venous pump due to paralyzed leg muscles. Therefore, a tilt tabl e with integrated stepping device (tilt stepper) was developed, which allows passive stepping movements for performing locomotion training in an early state of rehabilitation. Th e aim of this pilot study was to inve stigate if passive stepping and cycling movements of the legs duri ng tilt table training could stabilize blood circulation and prevent neurally- mediated syncope in healthy young adults. Methods: In the first experiment, healthy su bjects were tested on a tradit ional tilt table. Subjects who had a syncope or near-syncope in this condition underwent a second trial on the tilt stepper. In the second experiment, a group of healthy subje cts was investigated on a traditiona l tilt table, the second group on the tilt ergometer, a device that al lows cycling movements during tilt ta ble training. We used the chi-square test to compare the occurrence of near-syncope/syncope in both groups (tilt table/tilt stepper and tilt table/tilt ergometer) and ANOVA to compare the bl ood pressure and heart rate between the groups at the four time intervals (supine, at 2 minut es, at 6 minutes and end of head-up tilt). Results: Separate chi-square tests perfor med for each experiment showed significant differences in the occurrence of near syncope or syncope based on the device used. Comparison of the two groups (tilt stepper/ tilt table) in experiment one (ANOVA) showed that blood pressure was si gnificantly higher at the end of head-up tilt on the tilt stepper and on the ti lt table there was a greater increase in heart rate (2 minutes after head-up tilt). Comparison of the two gr oups (tilt ergometer/tilt table) in experiment 2 (ANOVA) showed that blood pressure was significantly higher on the tilt ergometer at the end of head- up tilt and on the tilt table the incr ease in heart rate was significantly larger (at 6 min and end of head-up tilt). Conclusions: Stabilization of blood circulation and preven tion of benign syncope can be achieved by passive leg movement during a tilt table test in healthy adults.

Address: 1 Spinal Cord Injury Center, Balgrist Un iversity Hospital, Zurich, Switzerland, 2 Orthopaedic Hospital of Heidelberg University, Department II, Heidelberg, Germany and 3 Hocoma AG, Medical engineerin g, Volketswil, Switzerland Email: David Czell* - dczell@balgrist .unizh.ch; Reinhard Schreier - [e-mail]; Rüdiger Rupp - [e-mail]-heidelberg.d e; Stephen Eberhard - [e-mail]; Gery Colombo - [e-mail]; Volker Di etz - [e-mail] * Corresponding author

Research Open Access Influence of passive leg movements on blood circulation on the tilt table in healthy adults David Czell* 1 , Reinhard Schreier 1 , Rüdiger Rupp 2 , Stephen Eberhard 1 , Gery Colombo 1,3 and Volker Dietz 1